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This position will investigate and prosecute various types of AHCCCS fraud cases including, but not limited to, involving the falsification of medical records and the filing of false or inflated Medicaid billing claims; thefts and embezzlements from AHCCCS clients and health care institutions; the illegal diversion of prescription drugs by health care providers; and the physical, sexual, and emotional abuse of residents being cared for in AHCCCS-funded facilities.
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This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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Work all assigned billing edits related to cardiac cath and interventional radiology technical claims within nThrive claims and Charge Capture Audit (CCA). For all assigned records and/or areas assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards.
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Attends meetings and travels for mandated training of Medicaid Control Units, usually out-of-state. Additionally, must possess knowledge of the practical factors that impact investigative and litigation decision and goals, including target and defendant responses, opposing counsel strategies and judicial perspectives and victim/ witness considerations; experience with negotiations; knowledge of financial considerations for the state of defendants.
$100,000 - $120,000 a yearFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Must be able to pass classes in and get a current certification in CPI, First Aid, CPR and Medicaid billing. Act as a resource to the Child Study Team, Problem Solving Team, and District Threat Assessment Team for a student who exhibits social/emotional/behavioral difficulties.
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AHCCCS number for Medicaid billing within four months of hire. Participates in MIPS (Medicaid in Public Schools) as directed. AHCCCS number for Medicaid billing within four months of hire.
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Knowledge of the AZ Regional Behavioral Health Authority (RBHA), AHCCCS Complete Care (ACC- Medicaid), and other health plans' provision of services requirements. Knowledge of DSM-5 and ICD-10 billing practices.
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The Senior Accountant reports directly to the Director of Reimbursement and is responsible for compiling, analyzing, interpreting, and presenting data primarily related to the revenue and accounts receivable allowance accrual estimate calculations of the Patient Financial Services (PFS) billing and claim collection process.
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The VP is responsible for the development, dissemination, and implementation of policies, standards, and related administrative policies in areas that may include, but are not limited to, Medicaid, HIPAA, fraud and abuse laws, state and federal false claim acts, unauthorized use of assets, improper or inadequate documentation, billing and coding and adherence to regulatory compliance and all applicable laws and regulations related to healthcare.
Full-timeExpandApply NowActive JobUpdated 27 days ago - UpvoteDownvoteShare Job
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Knowledge of patient registration, charge entry, billing, and medical policies. Working knowledge of Medicare, Medicaid, Commercial Insurance Payors, Workers Compensation, and Managed Healthcare.
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What You Bring to the Role Minimum high school diploma or GED Minimum of 2-3 years experience working in a medical field Medicaid Billing experience preferred Excellent customer service and communication skills About Spooner Spooner is a place for professionals with a growth mindset who want to push themselves to achieve excellence.
$19 - $21 an hourExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Medicaid Billing experience preferred. Review status of patient accounts to identify and resolve billing and processing problems in a timely manner. Resolve tasks assigned to you and to billing.
$19 - $21 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Revenue Operations Specialist will be responsible for review and resolution of outstanding insurance balances on Commercial, Medicare and Medicaid accounts. At least one (1-3) years of behavioral health and medical billing experience preferred.
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Follow all Medicaid billing procedures, including completing and maintaining all required documentation. Choose Kaleidoscope Kaleidoscope Education Solutions (KES) refers top-notch teaching and therapy professionals to our amazing clients in the Phoenix and the East Valley area.
$2,520 - $3,280 a weekFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Complete required documentation including IEPs, progress reports, and Medicaid billing. As a Remote Speech-Language Pathologist with TeleTeachers, you will have the unique opportunity to enjoy the benefits of remote work.
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billing medicaid jobs in Phoenix, AZ
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